Table of Contents
Introduction
Managing cardiology billing requires precise coding knowledge and attention to detail. This comprehensive guide covers every major code you’ll encounter in a cardiology practice, from routine visits to complex procedures.
Evaluation and Management (E/M) Services
Office/Outpatient Visits – New Patients
- 99201: Level 1 (Discontinued as of 2021)
- 99202: Level 2 – Straightforward medical decision making (MDM)
- 99203: Level 3 – Low MDM
- 99204: Level 4 – Moderate MDM
- 99205: Level 5 – High MDM
Office/Outpatient Visits – Established Patients
- 99211: Level 1 – Minimal presenting problems
- 99212: Level 2 – Straightforward MDM
- 99213: Level 3 – Low MDM
- 99214: Level 4 – Moderate MDM
- 99215: Level 5 – High MDM
Hospital Services
- 99221-99223: Initial hospital care
- 99231-99233: Subsequent hospital care
- 99238-99239: Hospital discharge services
- 99291-99292: Critical care services
Diagnostic Testing Codes
Electrocardiography
- 93000: ECG with interpretation and report
- 93005: ECG tracing only
- 93010: ECG interpretation and report only
- 93040: Rhythm ECG with interpretation
- 93041: Rhythm ECG tracing only
- 93042: Rhythm ECG interpretation only
Holter Monitoring
- 93224: 24-hour Holter monitoring (complete)
- 93225: Hookup and recording
- 93226: Scanning analysis with report
- 93227: Physician review and interpretation
- 93228: Mobile cardiac telemetry up to 30 days
- 93229: Technical support for mobile cardiac telemetry
Echocardiography
- 93303: Echo, congenital
- 93304: Echo, congenital follow-up
- 93306: Echo complete with spectral and color flow
- 93307: Echo without spectral and color flow
- 93308: Echo follow-up
- 93312: TEE probe placement and imaging
- 93315: TEE for congenital anomalies
- 93318: TEE for monitoring purposes
Stress Testing
- 93350: Stress echo
- 93351: Stress echo with contrast
- 93015: Cardiovascular stress test complete
- 93016: Physician supervision only
- 93017: Tracing only
- 93018: Interpretation and report only
Cardiac Catheterization
Diagnostic Procedures
- 93451: Right heart catheterization
- 93452: Left heart catheterization
- 93453: Combined right and left heart catheterization
- 93454: Coronary angiography
- 93455: Coronary angiography with bypass grafts
- 93456: Right heart catheterization with coronary angiography
- 93457: Right heart catheterization with coronary angiography and bypass grafts
- 93458: Left heart catheterization with coronary angiography
- 93459: Left heart catheterization with coronary angiography and bypass grafts
- 93460: Right and left heart catheterization with coronary angiography
- 93461: Right and left heart catheterization with coronary angiography and bypass grafts
Interventional Procedures
Coronary Interventions
- 92920: Percutaneous transluminal coronary angioplasty (PTCA), single
- 92921: Each additional vessel PTCA
- 92924: PTCA with atherectomy, single vessel
- 92925: Each additional vessel with atherectomy
- 92928: PCI with stent placement, single vessel
- 92929: Each additional vessel with stent
- 92933: PCI with atherectomy and stent, single vessel
- 92934: Each additional vessel with atherectomy and stent
- 92937: PCI for chronic total occlusion
- 92938: Each additional chronic total occlusion
- 92943: PCI for chronic total occlusion with atherectomy
- 92944: Each additional vessel chronic total occlusion with atherectomy
Structural Heart Procedures
- 93580: ASD closure device
- 93581: VSD closure device
- 93582: PFO closure device
- 93583: PVLS closure device
- 93590: Aortic valve replacement, percutaneous
- 93591: Aortic valve replacement, transapical
- 93592: Additional valve replacement
Common ICD-10 Codes
Hypertensive Diseases
- I10: Essential hypertension
- I11.0: Hypertensive heart disease with heart failure
- I11.9: Hypertensive heart disease without heart failure
- I12.0: Hypertensive CKD with stage 5 or ESRD
- I12.9: Hypertensive CKD without heart failure
- I13.0: Hypertensive heart and CKD with heart failure and stage 1-4 CKD
- I13.2: Hypertensive heart and CKD with heart failure and stage 5 CKD or ESRD
Ischemic Heart Disease
- I20.0: Unstable angina
- I20.1: Angina pectoris with documented spasm
- I20.8: Other forms of angina pectoris
- I20.9: Angina pectoris, unspecified
- I21.0-I21.4: Acute myocardial infarction (specific types)
- I21.9: Acute myocardial infarction, unspecified
- I25.10: Atherosclerotic heart disease without angina
- I25.110: ASHD with unstable angina
- I25.111: ASHD with angina pectoris with documented spasm
- I25.118: ASHD with other forms of angina
- I25.119: ASHD with unspecified angina
Arrhythmias
- I47.0: Re-entry ventricular arrhythmia
- I47.1: Supraventricular tachycardia
- I47.2: Ventricular tachycardia
- I48.0: Paroxysmal atrial fibrillation
- I48.1: Persistent atrial fibrillation
- I48.2: Chronic atrial fibrillation
- I48.91: Unspecified atrial fibrillation
- I49.01: Ventricular fibrillation
- I49.02: Ventricular flutter
- I49.1: Atrial premature depolarization
- I49.2: Junctional premature depolarization
- I49.3: Ventricular premature depolarization
Heart Failure
- I50.1: Left ventricular failure
- I50.20: Unspecified systolic heart failure
- I50.21: Acute systolic heart failure
- I50.22: Chronic systolic heart failure
- I50.23: Acute on chronic systolic heart failure
- I50.30: Unspecified diastolic heart failure
- I50.31: Acute diastolic heart failure
- I50.32: Chronic diastolic heart failure
- I50.33: Acute on chronic diastolic heart failure
- I50.40: Unspecified combined systolic and diastolic heart failure
- I50.41: Acute combined systolic and diastolic heart failure
- I50.42: Chronic combined systolic and diastolic heart failure
- I50.43: Acute on chronic combined systolic and diastolic heart failure
- I50.9: Heart failure, unspecified
Important Modifiers
- 25: Significant, separately identifiable E/M service
- 26: Professional component
- TC: Technical component
- 59: Distinct procedural service
- 22: Increased procedural services
- 52: Reduced services
- 53: Discontinued procedure
- 76: Repeat procedure by same physician
- 77: Repeat procedure by another physician
- 78: Return to OR for related procedure
- 79: Unrelated procedure during postoperative period
Documentation Requirements
Each procedure requires specific documentation elements for proper reimbursement. Key components include:
- Medical necessity
- Patient history and symptoms
- Physical examination findings
- Test results and interpretation
- Medical decision making
- Plan of care
- Time spent (when applicable)
- Risk factors and comorbidities
Billing Tips for Maximum Reimbursement
- Always verify insurance coverage and prior authorization requirements
- Document medical necessity thoroughly
- Use the most specific diagnosis codes available
- Include appropriate modifiers
- Submit clean claims within timely filing deadlines
- Monitor denials and appeal when appropriate
- Stay current with coding updates and changes
- Perform regular internal audits
- Maintain compliance with documentation requirements
- Outsourcing your billing to a specialized medical billing company ensures your codes are thoroughly reviewed for accuracy, helping prevent denials and maximize reimbursements—though we are not a coding company, we meticulously verify the correctness of submitted codes.
- Consider using certified coders for complex cases
FAQ: Cardiology Billing
Q: How do I use the -25 modifier correctly for cardiology?
A: Use it when billing for an E/M service with a procedure on the same day. For example, if a cardiologist evaluates chest pain and performs an ECG, both services are billable—but the E/M code needs the -25 modifier.
Q: What is the difference between -26 and -TC modifiers?
A: The -26 modifier is for the professional component (e.g., interpretation of an ECG), while -TC covers the technical component (e.g., use of the ECG machine). Use both if you’re billing separately for professional and technical services.
Q: How do cardiology practices reduce claim denials?
A: Keep documentation thorough, verify insurance before procedures, use appropriate modifiers, and monitor denial trends. Using an EHR with built-in coding tools also helps catch errors early.
Q: What procedures require prior authorization in cardiology?
A: High-cost diagnostic procedures such as nuclear stress tests, cardiac MRIs, and some catheterization procedures often require prior approval from the payer.
Q: How can I handle denied cardiology claims efficiently?
A: Investigate the reason for denial, correct the errors, and resubmit the claim. Appeal if necessary, providing supporting documentation like medical necessity notes.
